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Many invasive fungal diseases have no characteristic signs or symptoms, and may give negative blood cultures; therefore, clinician may decide to start empirical antifungal therapy particularly in high risk patient (e.g., hematopoietic stem cell transplant, solid organ transplant, and AIDS patients). This increases the incidence of appearance of resistant fungal strains to antifungal drugs. Traditional methods for diagnosis such as wet mount examination and microbiological cultures remain the gold standard methods for fungal disease diagnosis. However, they are time-consuming, insensitive, and have a limited impact on clinical decision-making. Significant progress has recently achieved in diagnostic tools of fungal disease. Antigen and antibody based assays, molecular techniques, and MALDI TOF spectrometry technique and nanotechnology offer more rapid, sensitive and accurate results.

Summary Background Healthcare-associated infection (HAI) is a major problem in healthcare facilities and is associated with increased morbidity and mortality and prolonged hospital stay. This study aims to determine the incidence rate, risk factors, and bacterial aetiology of HAI in a tertiary care hospital in Mansoura, Egypt. Methods This is a prospective observational study carried out over 12 months in different departments of Mansoura New General Hospital (MNGH). Data were collected from patient's records and laboratory results of the ongoing HAI surveillance program. Results The incidence of HAI was 3.7% among 6912 patients studied. The independent predictors of HAI were multiple devices (AOR=88.1), central venous catheter (CVC) (AOR=34), urinary catheter (AOR=28.9) and length of stay >20 days (AOR=3.1). Surgical site infections (SSI) were the most frequent (24%) followed by catheter associated urinary tract infections (CAUTI) (20%). The most frequently isolated pathogens were Klebsiella spp. (27.2%), and E. coli (18%). Conclusions HAI is a significant problem in MNGH. Klebsiella spp. were the predominant causative organisms of HAI, as has been described in other studies from developing countries.

Background: The frequency of nosocomial yeast infections has increased dramatically in the recent years. They are considered an important cause of morbidity and mortality in immunocompromised cancer patients. The majority of yeast infections are caused by Candida species. However, species like Trichosporon and Rhodotorula should be considered as possible infectious agents as well. Objectives: This study aimed at determining the prevalence of yeast species, their distribution among patients and the antifungal susceptibility profile at Oncology Center, Mansoura, Egypt. Methods: From December 2016 till November 2017, cancer patients who developed infective episodes two days or more following hospital admission were included in the study. Clinical samples were collected according to the site of infection using standard sterile procedures. Blood samples were cultured using the BACT-ALERT system. Fungal identification and susceptibility testing were performed by Vitek 2 system. Results: Eighty-seven fungal strains were obtained from our patients. A higher isolation rate was observed in urine samples (47.1%) followed by oropharyngeal (24.1%) and blood (21.8%) samples. The majority of the yeast species were Candida albicans (40.2%), C. tropicalis (14.9%), C. parapsilosis (9.2%), C. famata (6.9%) and C. guilliermondii (6.9%). Out of the 87 samples, 8 (9.2%) were resistant to fluconazole, 7 (8.0%) were resistant to flucytosine, 5 (5.7%) were resistant to voriconazole and amphotericin B, and no sample was resistant to caspofungin or micafungin. Conclusions: Vitek 2 system offers a novel method for the early identification and susceptibility testing of different yeast species. It helps to minimize the risk for emergence of resistant species and reduce mortality rates, particularly in cancer patients.

Objective: To determine the prevalence of Blastocystis hominis (B. hominis) among pre-school children and evaluate the different staining techniques for its detection in stool. Methods: A total of 300 children of both sexes aged 2-5 years were included in this study. Each child was subjected to examination of stool sample using iodine, safranine methylene blue (SMB) and modified Ziehl-Neelsen (MZN) stains. Immunofluorescence antibody (IFA) stain was applied on stool specimens of 30 cases only. Results: Results showed a total prevalence rate of 53%. A higher prevalence was detected among children aged 4-5 years and most of them were males. The majority of cases (82.8%) infected with Blastocystis alone were symptomatic. Fecal parasite burden was significantly higher in symptomatic than asymptomatic cases, so B. hominis should be considered as a pathogenic parasite. IFA stain was proved to be the most sensitive (73.3%) followed by MZN (68.2%), iodine (59.1%) and SMB (50%) stains. Conclusions: This study confirmed the pathogenic potential of B. hominis and shed light on the great need to promote the hygienic standards among the risky group of children. IFA staining technique though having the highest sensitivity, it is suitable for use in large hospitals or public health laboratories in developed countries owing to its high cost. The MZN staining technique had a significantly higher sensitivity than iodine and SMB stains, and was more feasible to be used in laboratories with limited funds as in Egypt, because it is cheap, rapid, easy to perform and clarify the definitive morphological details of the parasite.

Tuberculosis (TB) is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. It has been present in humans since antiquity. In the past, tuberculosis has been called consumption, because it seemed to consume people from within, with a bloody cough, fever, pallor, and long relentless wasting. In Egypt, TB constitutes the second most important public health problem after schistosomiasis. Although Egypt has relatively low levels of TB according to data from the World Health of Organization, 2005:66% of TB cases occur among the socially and economically productive age groups of 15 to 54 years. According to Ministry of Health and Population (MOHP), Egypt; tuberculosis control is carried out through 111 chest centers and 39 chest disease hospitals. Treatment failure accounts for 3%–5%of the treatment outcome of new smear positive cases and 13%–17% of retreated cases and this is due to non-compliance to treatment, defi cient health education to the patient, poor patient knowledge regarding the disease and diabetes mellitus as co-morbid. The incidence and prevalence of tuberculosis in Egypt has been declining due to increased efforts of the MOHP. Prevalence dropped from 88/100,000 population in 1990 to 24 in 2008, according to data from WHO. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2013; X(1); 43-49 DOI: http://dx.doi.org/10.3126/saarctb.v10i1.8677

Background: Device-associated hospital-acquired infections (DA-HAIs) are a threat to patient safety, particularly in the intensive care units (ICUs). Methods: A prospective observational study was carried out for 12 months from January 2017 to December 2017 in five ICUs including General intensive care unit (General ICU), Cardiology care unit (CCU), Neonatal intensive care unit (NICU), Pediatric intensive care unit (PICU), and Neurosurgery intensive care unit (Neurosurgery ICU) of Mansoura New General Hospital (MNGH). Data were collected from patient's file and laboratory results according to definitions of CDC. DA-HAIs were calculated by dividing the total number of device associated infections (DAIs) by the total number of device days and multiplying the result by 1,000. Results: In the current study 1,666 patients hospitalized for 11.280 days in the different ICUs. These patients acquired 91 DA-HAIs. The most frequent DA-HAIs (per 1000 device-days) were Ventilator-associated Pneumonia (VAP) (10.9), central line-associated blood stream infection, (CLA-BSI) (5.9), and catheter-associated urinary tract infections (CA-UTI) (5.6). The urinary catheter utilization ratio was 0.54, central line utilization ratio was 0.33, and ventilator utilization ratis was 0.28. The most frequently isolated organisms were Klebsiella spp. (34%) and E.coli (20.9%). The most frequent bacteria causing VAP, CLA-BSI, and CA-UTI were Klebsiella spp. (60%), Staphylococcus aureus and Enterococcus spp (27.3% for each)., and E.coli (41.2%) respectively.. Conclusion: Surveillance of DA-HAIs is the first step to improve infection control activity and to implement preventive bundles measures in the intensive care unit.

Hepatitis B virus (HBV) and hepatitis D virus (HDV) sequences among HBV carriers from Egypt have not been evaluated sufficiently. The genotypes of HBV isolated from 105 serum samples from Egyptian carriers were determined. Four complete genomes and 11 entire preS1/S2/S genes were sequenced and evaluated. All serum samples were classified into HBV genotype D using serologic and genetic methods. The length of four complete nucleotide sequences was 3,182 bp. In all 15 samples, the common 33 nucleotides (11 amino acids) deletions in the preS1 region specific for HBV genotype D were observed. In the phylogenetic analysis based on the complete nucleotide sequences, all samples were clustered with the HBV isolates reported from previously Western and Mediterranean countries with nucleotide homology ranging from 96.0–98.0%. Of 75 HBsAg positive samples, anti-HDV was found in 15 (20%), and HDV RNA was detected in 9 of 15 (60%). The proportion of the patients with liver disease was higher in HBV carriers of anti-HDV positive with HDV RNA than in HBV carriers of anti-HDV positive without HDV RNA (P

Increased application of DNA fingerprinting has advanced the understanding of the dynamics of TB epidemiology. Typing of MTB is important for case tracing, and identifying community outbreaks. Objective: We aim to detect pattern of drug resistance and molecular genotypes of MTB at Mansoura hospitals using PCR-RFLP. Methodology: 123 sputum samples obtained from ZN smear positive cases were cultivated on Lowenstein Jensen (LJ) medium, out of them 67 specimens (54.5%) were positive culture. Genotypic analysis was done by the RFLP method after DNA extraction and PCR amplification. The susceptibilities to isoniazid (INH), rifampicin (RIF), streptomycin (STR) and ethambutol (EMB) were determined by the indirect nitrate reductase assay. Results: The identified restriction patterns yielded 3 bands with different sizes and revealed 3 genotypes only. Restriction patterns are equal to 245/125/100 bp, and 245/125/80 bp fragments for Bst EII digests and 155/140/60 bp (MTC), 155/110/70 bp (intracellulare) and 160/140/70 bp (malmoense) fragments for Hae III digest. Genotyping of MTB detected that MTC was the commonest genotype among studied cases 49/67 (73.1%), followed by Mycobacterium intracellulare 14/67 (20.9%), while Mycobacterium malmoense had the least incidence 4/67. There was significant increased risk of resistance to STM, RIF, ETH and INH with M. intracellulare (p = 0.021, p